Arthritic Feet's Shot of Hope

New York Post—August 14, 2007

If your doctor has unsuccessfully tried curing your arthritic big toe or ankle using oral medications or cortisone injections, you have yet another viable nonsurgical option...the use of a joint "lubricant" called hyaluronic acid.

Hyaluronic acid, a lubricant used to treat knee arthritis, may also play a role in treating arthritic toes and ankles. This substance exists naturally in many tissues of the body such as cartilage, skin and the vitreous humor of the eye.

Currently, there are few effective nonsurgical options for treating arthritis on the foot. Most people are not inclined to have ankle and bunion operations unless they are absolutely necessary, as these surgical procedures often require long periods of rehabilitation and often do not achieve the best result.

"If people have failed to get benefits from standard treatments like oral medications and cortisone injections, hyaluronic acid injections may help the right candidates," says Dr. Vijay B. Vad, a sports-medicine specialist at Hospital for Special Surgery and author of "Arthritis Rx: A Cutting-Edge Program for a Pain-Free Life" (Gotham, 2006).

"An arthritic joint loses its ability to produce the high-quality joint lubricant, which is essential in pain-free and healthy functioning of the joint," Vad says. But by injecting hyaluronic acid into the arthritic joint, doctors can restore elasticity and viscosity, which are essential for maintaining healthy and necessary joint function.

"The process involves getting two to three injections of hyaluronic acid into the arthritic joint under ultrasound guidance, which guidance provides precise placement of the medication in the joint," Vad says.

This is all combined with a prescription foot orthotic device that provides better stability to the joint and redistributes force through the foot and ankle in a more efficient and mechanically beneficial manner.

The patient is then encouraged to engage in a proper exercise regimen such as bicycling or walking, but also told to start icing the joint on a regular basis, particularly after exercise. Physical activity and mobility are encouraged, as all this helps to increase the range of motion in the affected joint and break up scar tissue caused by inflammation.

Vad maintains that patients best suited to do well with these injections are normally very active, have no major mechanical malalignment issues and are not grossly obese.

"For the right candidate, this could mean restoration of quality of life without resorting to major surgical intervention," Vad says.

The author of this piece, Rock Positano, DPM, M.Sc., MPH, is the director of the Non-surgical Foot and Ankle Service at Hospital for Special Surgery in New York. His column appears every Tuesday in the New York Post.